Depression in old age

Researchers have reported a high prevalence of depression among older Hispanics
in the United States when compared to other ethnic groups. Cultural variations in the
perception of depression sometimes make it difficult to recognize the disorder resulting in
older Hispanic patients not being diagnosed and not receiving appropriate treatment. The
purpose of this study was to explore older Hispanics’ explanatory model of depression
and identify culture-specific factors that may help in the recognition and treatment of
depression. A mixed-method design that combined qualitative and quantitative methods
was used. Fifty participants were interviewed using Kleinman’s Explanatory Models
ethnographic approach with a vignette variation, the Center for Epidemiologic Studies
Depression Scale (CES-D), and the Cross Cultural Measure of Acculturation (CCMA).
The findings suggest that this group of older Hispanics did not recognize
depression as an illness but rather as the result of life stressors and personal weaknesses.
People who experience depressive symptoms were described as being crazy, bored,
worried, or having a problem of the nerves. These culturally coded terms may confound diagnosis among many Hispanics who find depression an unacceptable and shameful
condition. This cultural pattern seemed to prevail among low and high-acculturated
individuals which may complicate the diagnosis of depression by health care providers.
This study highlights the complexity and diversity of this group of older
Hispanics’ conceptual model of depression. The results of this study will contribute to
nursing care by providing additional information that will help professionals when
working with Hispanic patients with depression. Findings expand our understanding of
older Hispanics (high and low-acculturated, depressed and non-depressed) groups’
conceptualization of depression and can be used to inform the adaptation of culturally
relevant approaches to better serve the Hispanic community in this country.

The graying of America as a sociological and health care phenomenon continues to dictate the demand for creative and innovative interventions that can directly influence the quality of life of nursing home residents. Creative Reminiscence is a program that fosters the active reliving of the past through narration, such as in story-telling, and the use of creative art expression to uncover meaningful life events or valuable life experiences. The purpose of this study was to investigate and describe the meaningful life events elicited by the experience of Creative Reminiscence using a phenomenographic approach. Existing (archived) data-transcribed interviews, poetry and painting on planters that were obtained from 20 participants of the Creative Reminiscence program entitled Le Jardin de Sante were analyzed. Five variations of meaningful memories evoked by Creative Reminiscence were identified. These are described as follows: (a) memories that rejuvenate the elder's sense of connectio n; (b) memories that revive the elder's sense of love and intimacy; (c) memories that restore the elder's sense of being; (d) memories that reassert the elder's sense of control; and (e) memories that reinstitute the elder's sense of purpose. In a caring interaction with Creative Reminiscence, the nursed are able to transcend, moving back in time (past) to appreciate segment(s) of their lives, with triumphs and disappointments that give meaning to their inner conflict/human struggle (present), and integrate a sense of confidence and acceptance of their lives to sustain well-being and a sense of wholeness. This research highlights the similarities and differences in the description of memories by the nursing home residents evoked during Creative Reminiscence.